Baxi Sangita, Cabreros Irineo, Meredith Lisa S, Holliday Stephanie Brooks, Martinez Jose, Piquado Tepring
RAND Corporation, Santa Monica, California.
J Head Trauma Rehabil. 2023;38(5):391-400. doi: 10.1097/HTR.0000000000000828. Epub 2022 Oct 21.
To determine the US military healthcare professionals' knowledge and training preferences to improve diagnosis and management of concussion sustained in nondeployed settings.
US military healthcare professionals (physicians, physician assistants, and nurse practitioners) completed online surveys to investigate practices, knowledge, and attitudes about concussion diagnosis and treatment, as well as preferences on future training. There were 744 responses from active duty US military healthcare providers, all of whom had cared for at least one patient with mild traumatic brain injury (mTBI) in the previous 24 months.
The majority of physicians reported they were confident in their ability to evaluate a patient for a new mTBI (82.1%) and order appropriate imaging for mTBI (78.3%). Accuracy of identifying "red flag" symptoms ranged between 28.2% and 92.6%. A Likert scale from 1 ("not at all confident") to 4 ("very confident") was used to assess providers' confidence in their ability to perform services for patients with mTBI. With respect to barriers to optimal patient care, nurse practitioners consistently reported highest levels of barriers (90.8%).
Although US military providers regularly care for patients with concussion, many report experiencing barriers to providing care, low confidence in basic skills, and inadequate training to diagnose and manage these patients. Customized provider education based on branch of service and occupation, and broader dissemination and utilization of decision support tools or practice guidelines, and patient information tool kits could help improve concussion care.
确定美国军事医疗专业人员的知识水平和培训偏好，以改善在非部署环境中发生的脑震荡的诊断和管理。
美国军事医疗专业人员（医生、医师助理和执业护士）完成了在线调查，以调查有关脑震荡诊断和治疗的实践、知识和态度，以及对未来培训的偏好。来自美国现役军事医疗服务提供者的回复有744份，所有这些提供者在过去24个月中都至少护理过一名轻度创伤性脑损伤（mTBI）患者。
大多数医生报告称，他们对评估新的mTBI患者的能力（82.1%）以及为mTBI患者开具适当影像学检查的能力（78.3%）有信心。识别“红旗”症状的准确率在28.2%至92.6%之间。使用从1（“完全没有信心”）到4（“非常有信心”）的李克特量表来评估提供者对为mTBI患者提供服务能力的信心。关于优化患者护理的障碍，执业护士始终报告称障碍水平最高（90.8%）。
尽管美国军事医疗服务提供者经常护理脑震荡患者，但许多人报告在提供护理方面遇到障碍、对基本技能信心不足以及诊断和管理这些患者的培训不足。根据服务部门和职业定制提供者教育，以及更广泛地传播和使用决策支持工具或实践指南以及患者信息工具包，可能有助于改善脑震荡护理。
